Geneva Health Forum Archive

Tag: Obesity

Professor at the medical faculty of the University of Geneva and director of CERAH, Switzerland

She obtained a medical degree at the University of Geneva (1978), trained as a specialist in Internal Medicine (1986) and completed a Doctor in Public Health at the Harvard School of Public Health (1992).

Between 1982 and 1990 Doris Schopper spent several years with Médecins Sans Frontières (MSF) in the field. She was president of the Swiss branch of MSF (1991–1998) and twice president of the MSF International Council during this period. In 2001 Doris Schopper was asked to constitute an Ethics Review Board for MSF International.

Since then she has chaired the Board coordinating the ethical review of MSF research proposals and providing advice on ethical matters to the organisation.

Doris Schopper also worked as health policy adviser in the Global Programme on AIDS at WHO headquarters in Geneva (1992-95).

Further international work includes two years as senior health policy adviser at the Swiss Tropical Institute and developing several policies and strategies for WHO (e.g. guideline for policy makers on national policies for violence and injury prevention; strategy for mother-to-child transmission of HIV in Europe; WHO-wide strategy on child and adolescent health).

Professor Schopper has also been responsible for the development of health policies and strategies at the national and regional level in Switzerland (e.g. Swiss National Cancer Control Programme 2005-2010; framework to prevent obesity at the national level; comprehensive health policy for the canton of Geneva). She is member of the board of Pro Victimis Foundation-Geneva since 2003, and president since 2010.

In November 2012, Doris Schopper was appointed member of the International Committee of the Red Cross (ICRC).

1Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health , New York , United States, 2Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States, 3Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States.

Country - ies of focus

United States

Relevant to the conference tracks

Governance and Policies

Summary

The overall aim of this project is to systematically detail the timing and substance of health-relevant New York City (NYC) policies and initiatives from 2002-2013. This is the initial phase of research proposing to evaluate the effectiveness of these efforts in reducing chronic disease morbidity and mortality rates. Local governments around the United States have taken policy action to mitigate the adverse effects of health determinants beyond the health care sector, such as tobacco smoke, physical inactivity, low dietary quality, and air pollution. NYC has been at the vanguard of municipal efforts to decrease the chronic disease using a multi-sectorial approach.

Background

Chronic diseases represent the leading causes of death and disability among developing and developed nations (Yach et al, 2004; Beaglehole & Bonita, 2008). Among the most deadly chronic diseases, are atherosclerotic cardiovascular disease (CVD) and cancer, accounting for >65% of global mortality in 2002. This is projected to remain stable through the year 2020 at which point CVD and cancer together will account for nearly 40 million global deaths – nearly twice the number of deaths projected due to injuries and infectious disease combined (Yach et al, 2004). Respiratory diseases including emphysema and chronic obstructive pulmonary disease (COPD) are projected to become the third most common cause of death by 2020, accounting for another 10% of global mortality. It is well established that leading modifiable risk factors for chronic disease development include tobacco use, excess adiposity, low dietary quality, and exposure to particulate air pollution. The increasing concentration of populations in urban centres, while previously discussed as potentially contributing to risk (Vlahov, 2002), also represents an opportunity to enhance the public’s health through the enactment of local health promotion efforts in densely populated cities such as New York City.

Objectives

Over the past twelve years, NYC has been led by the Michael Bloomberg administration, which has prioritized public health initiatives in response to the chronic disease burden of New Yorkers. Bloomberg worked closely with Health Commissioners, but the efforts were not limited to Department of Health and Mental Hygiene. A variety of governmental approaches including taxation, regulation, marketing/advertising campaigns, and infrastructure investments were proposed and implemented throughout the five boroughs. If the Bloomberg administration significantly decreased the chronic disease burden of the city dwellers, such policies can guide the nation to similar results. Currently, a comprehensive catalogue of all health-related NYC policy proposals, enacted laws and implemented initiatives does not exist.The aim of this research project was to systematically catalogue the nature and deployment of policies and initiatives relevant to public health. We will specifically focus on policies and programs enacted in NYC during the Bloomberg Administration, 2002-2013, related to the following four chronic disease risk factors: 1) tobacco, 2) obesity, 3) diet quality, and 4) air quality.

Methodology

This study identifies policies and initiatives relevant to public health proposed and enacted in NYC. Specifically, it addresses the following research questions: (1) How many policies and initiatives related to public health were proposed and enacted in NYC legislation during 2002-2013 (2) Which local governmental agencies and departments were involved in the enact of such efforts.The systematic development of the catalogue of relevant policies and initiatives was generated in three phases. First, online state and city legislative record portals (assembly.state.ny.us, nyc.gov, legistar.council.nyc.gov/Legislation.aspx) and the PubMed database have been used with search terms for each of the selected chronic disease risk factors. Secondly, the searches were narrowed by selecting specific terms for each of the four chronic disease risk factors. For example, when searching legislation in regards to air pollution, the following terms, (air quality, air pollution, and greenhouse gases) were systematically used to provide consistency and a thorough assessment of relevant policies. Lastly, the search was restricted to include only the years of 2002-2013, the Bloomberg Administration’s term in office. The final catalogue includes the policy legislation number, date created, date enacted (if applicable), data enforced (if applicable), current status (as of August 2013), the primary agency that sponsored the bill, and a brief description. Note only citywide policies and regulations were included in the final catalogue.

Results

Overall during 2002-2013 there were a total of 113 policies relevant to public health that were introduced and 33 enacted. Legislation that reduced the risk factor of tobacco included 33 introduced and 7 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated passed includes: Smoke Free Act of 2002, Cigarette Tax Increase, Smoking Ban at Abatement Sites, Smoking Ban at Construction Sites, Smoking Ban at Hospitals, Tobacco Product Regulation, and Smoke Free Act of 2002 (Amendment). Legislation that reduced the risk factor of air quality included 32 introduced and 12 enacted policies. The New York City Council’s committee of environmental protection sponsored the majority of this legislation. The most notable legislation passed includes: Use of clean heating oil in New York City, Requiring retrofitting and the use of ultra-low sulphur diesel fuel for school buses that transport fewer than 10 students at one time, and City's purchase of cleaner vehicles. Legislation that reduced the risk factor of physical activity included 13 introduced and 2 enacted policies. The New York City Department of Health and Mental Hygiene sponsored the majority of this legislation. The most notable initiatives include the increase of bike lanes throughout the city as well as the Citi Bike public bike sharing system. Legislation that reduced the risk factor of diet quality included 35 introduced and 12 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated proposed was the Sugary Drink Size Ban and Minimally nutritious food ban in schools. The most notable legislation passed includes Maximizing the enrolment of eligible New Yorkers in the food stamp program and the Trans fats ban.The process of developing the catalogue of public health related polices and initiatives is limited by the information that was available on the online city and state portal as of August 2013. In addition, some citywide initiatives were programs that did not require legislation thus those projects and programs are not included in the presented catalogue. Moreover, at this time the health outcome data has not been analysed thus it is not possible to quantify the impact of such polices on the health of New Yorkers which is our overall goal.

Conclusion

This initial effort has highlighted that changing temporal trends in chronic disease outcomes may be attributed to one or many of the concurrent efforts, and evaluations of any one approach should be at once cautious and clever. The catalogue presented is the preliminary phase of an on-going research project to identify the magnitude and effect municipal policies impact health outcomes. Our future research includes strategies to place the temporal patterns of legislation relevant to each risk factor (Figure 2) in the broader context of other local or citywide efforts. Through this work, it will be possible to describe the cumulative “dose-response” relationship of municipal policy initiatives with population health outcomes. Strategies are also proposed using outcome specificity, differential latency periods, and multiple control comparisons that may help us to distil some evidence on the relative effectiveness of particular policies or risk factor targets. Further, we hope through an examination of scientific citation networks to shed light on the evidence base supporting such efforts. This consensus building analysis aims to provide a clearer picture of the stages at which scientific knowledge may inform decision-making, and the opportunities for municipal policies to serve as natural experiments to foster the generation of new scientific knowledge. Upon the completion of this research information about how local policies are developed, implemented can be applied to the future development of disease prevention polices.

Diabetes is a global epidemic that has traditionally lacked proper attention, a situation the International Diabetes Federation (IDF) is working to revert through integrated advocacy and communication efforts. IDF pushed for a UN High-Level Meeting on Non-communicable Diseases, held in 2011 and resulted in a Political Declaration on NCD prevention and control, placing diabetes high on the global health agenda. IDF also implements campaigns such as “Take a Step for Diabetes” to raise awareness on diabetes to an increasingly broader audience thanks to social media. The combined advocacy and communications efforts result in campaigns to help reduce risk factors and raise awareness on diabetes.

Background

Diabetes and Noncommunicable Diseases (NCDs) are the leading cause of death and disability worldwide - accounting for 34.5 million of the 52.8 million global deaths in 2010 (65%). They exact a heavy and growing toll on physical health, economic security and human development.A global epidemic at crisis levels, diabetes affected 371 million people in 2012 and the number is due to increase to 552 million in 2030.The United Nations Political Declaration on NCD Prevention and Control raised diabetes/NCDs to the top of the international agenda and led to the adoption by the 66th World Health Assembly (WHA) of the Global Monitoring Framework (GMF). This sets out 25 indicators to monitor progress towards the achievement of nine voluntary global targets by 2025 – including halting the rise in diabetes and obesity.

Therefore, advocating for health strategies and promoting social mobilisation to decrease NCD risk factors is vital. This can be achieved through awareness-raising communications that will have a positive effect on improving both diabetes/NCDs management and preventing the rise of new cases of diabetes and NCDs.

Objectives

Despite its consequences, diabetes continues to lack proper attention: half of all people with diabetes in 2012 – a shocking 186 million – were undiagnosed and type 2 diabetes is increasing worldwide at an alarming rate. Raising awareness of the risk factors and promoting healthier lifestyles have the double impact of improving diabetes management and halting its rise.
The International Diabetes Federation (IDF) – whose mission is to promote diabetes care, prevention and a cure worldwide – has two objectives to revert the present situation: advocate for political commitments and increase public awareness.INFLUENCING POLICY
In 2009 IDF, the Union for International Cancer Control, the World Heart Federation and the International Union Against Tuberculosis and Lung Disease formed the NCD Alliance (NCDA), a highly influential civil society force focused on placing non-communicable diseases (NCDs) on the political agenda.
IDF and NCDA have engaged in high-level advocacy to achieve this effect. IDF and NCDA campaigned for a UN High-Level Meeting on NCDs, held in September 2011 which was a major milestone in the history of diabetes and other NCDs. During the Summit IDF and NCDA influenced political negotiations to secure strong outcomes for diabetes and NCDs. The unanimously adopted Political Declaration on NCD Prevention and Control, opened the door for further advocacy efforts towards a Global Monitoring Framework (GMF). This was finally endorsed by the World Health Assembly in 2013. The GMF has 25 indicators to monitor progress to the achievement of nine voluntary global targets by 2025 – including halting the rise in diabetes and obesity.
IDF and NCDA’s work does not finish with the adoption of these global targets. IDF, its Member Associations and NCDA continue to work to monitor the progress governments make on their promises and to press the case for including NCDs in a global development framework post-2015.SOCIAL MOBILISATION
Despite the political will to stop the current diabetes epidemic that is reflected in the adoption of these nine voluntary global targets, there must be more advances. There will be no change unless both people with diabetes, and those at risk of developing the condition, are aware of the risk factors and willing to adopt healthier lifestyles. With that objective IDF has set in motion the social mobilisation campaign “Take a step for diabetes”, as part of the 5-year World Diabetes Day theme “Diabetes: education and prevention”.

Methodology

Over the last four years World Diabetes Day has focused on raising awareness of the warning signs and risk factors of diabetes, highlighting the serious global threat that it poses, promoting simple and cost-effective measures to prevent the further rise of type 2 diabetes and the importance of diabetes education from a young age.With the goal of keeping the global commitments on diabetes made during the 2011 UN Summit on NCDs on the global health agenda, IDF launched the 2013 campaign “Take a Step for Diabetes” in March 2013, marking the final year of the “Diabetes: education and prevention” campaign.Conceived as a new way of raising awareness, inspiring local communities and promoting membership “Take a Step for Diabetes” has been designing as an innovating, engaging programme. It encourages people to make a symbolic donation of steps accrued through activities that help promote diabetes awareness, improve the lives of people with diabetes, promote healthy lifestyles or reduce one’s individual risk of developing diabetes. A total of 32 activities – ranging from wearing blue to running a marathon – can be done repeatedly. The aim is to reach 371 million steps – one for each person with diabetes in the world.

The main target groups are IDF member associations, other diabetes-related organisations, young leaders in diabetes, health professionals and community groups promoting healthy nutrition and physical activity. However, everyone – individuals and groups - is invited to register on the campaign website (steps.worlddiabetesday.org) and submit steps, providing a short description of the activities performed. The steps are collected on an online platform that displays the total number of steps submitted and the gap to the 371 million target.

This campaign is widely promoted through all IDF communication channels: website, social media (Facebook, Twitter, YouTube), newsletters (IDF, World Diabetes Day, World Diabetes Congress) and events where IDF has a stand. Specific communication materials have also been developed for the campaign including web banners, promotional videos, posters promoting key messages, a smartphone application, merchandise and an online toolkit providing information and resources on diabetes.

The “Take a Step for Diabetes” campaign will be widely promoted in the run up to and on World Diabetes Day – November 14 – and will officially end at the World Diabetes Congress Melbourne 2013 – 2-6 December.

Results

The IDF campaign “Take a Step for Diabetes” has been designed to reach not only people and organisations strongly connected with diabetes – IDF regions and member associations, other diabetes-related organisations, community groups active in promoting healthy lifestyles, young leaders in diabetes, health professionals – but everyone who is interested in promoting the diabetes cause and furthering IDF’s mission.One of the campaign’s goals is to involve as many people as possible. The use of social media – mainly Facebook and Twitter – is essential in reaching a broad audience and engaging new publics in constructive dialogue. With more than 21.000 fans on Facebook and 13.000 followers in Twitter informed daily about the campaign, “Take a Step for Diabetes” has proven to be a powerful instrument for social mobilisation.More traditional means of drawing attention to the campaign are also used: the WDD newsletter had over 25.000 subscribers in September 2013 and, since the launch of the campaign in March the WDD website had achieved more than 100.000 views.

By the end of September 2013 over 450 individuals and groups had registered on the campaign online platform and performed around 8000 activities, accruing more than 332 million steps. The achievement of 90% of the target, 371 million steps by December 2013 which is 3 months in advance of the deadline, reflects the campaign’s impact and success.

However, as IDF is encouraging its member associations and other organisations and groups to organise WDD awareness activities – particularly during the month of November and WDD (November 14), a significant hike in the submitted number of steps is expected around those dates. Considering that the initial 371 million steps target will possibly be achieved before then (October), and the campaign does not end officially until the World Diabetes Congress 2013 in December, it is likely that IDF may increase the current steps to make the goal more ambitious.

Once the target is achieved and the campaign is over, IDF will send an open letter to the United Nations Secretary General Ban Ki-Moon on behalf the “Take a Step for Diabetes” participants. The great social mobilisation achieved through this campaign will be used to advocate for the global commitments on diabetes made during the 2011 UN Summit on NCDs to be kept on the global health agenda.

Conclusion

Diabetes is a massive global burden with brutal health and socio-economic consequences. Although type 2 diabetes – which accounts for the vast majority of the cases worldwide – is largely preventable, the number of affected people is increasing in every single country. Tackling the current situation is a health priority for which interdisciplinary collaboration is imperative.Advocacy and communication are two inextricably linked working areas with the common objective of raising awareness. While advocacy is focused on influencing governments and key authorities to develop more comprehensive policies and strategies, communication promotes dialogue by delivering a series of messages to the general public. Both of them have a big role to play in overcoming the diabetes epidemic.The foundation of the NCD Alliance, of which IDF is founding member, was a clear advocacy milestone in combatting the NCDs and diabetes outbreak. As a network of more than 2,000 organisations, the NCDA is using its powerful voice to press governments into giving urgent response to NCDs as was shown by the UN High Level Meeting in 2011. The adoption of the GMF with its nine voluntary global targets to achieve by 2015 is another NCDA victory.

Political commitments on diabetes and NCDs are of great importance but would have little impact if the population is not aware of the risk factors to which we all are exposed. Communication campaigns such as “Take a Step on Diabetes” are perfect tools to promote healthy lifestyles and raise awareness on those risk factors. Social media has meant a revolution in this discipline, as now it is possible to reach a much broader audience than previously. In addition, an engaged population is another influential force for holding governments accountable for their political commitments.

Advocacy and communication are continuously interacting and frequently the outcome of one discipline can be used as a tool by the other. On the occasion of the achievement of the “Take a Step for Diabetes” campaign target a letter will be sent to the UN Secretary General Ban Ki-Moon, to continue advocacy efforts on keeping diabetes and the NCDs high on the political agenda. The constant feedback between advocacy and communication is a mechanism that needs to be continuously strengthened, to ensure the best outcomes in the fight against diabetes and NCDs.

1 Community Medicine, University of Colombo, Colombo, Sri Lanka, 2 Department of Community Medicine- retired, University of Colombo, Colombo, Sri Lanka, 3Department of Geology, University of Peradeniya, Kandy, Sri Lanka.

Country - ies of focus

Sri Lanka

Relevant to the conference tracks

Chronic Diseases

Summary

There is a tremendous increase in chronic diseases worldwide. A similar pattern is observed in Sri Lanka. Physical inactivity contributes to 6% of deaths globally and is identified as the fourth leading risk factor for mortality due to chronic diseases. There is sparse knowledge of the profile of the risk factors of chronic diseases as well as inadequate knowledge of the pattern of physical activity in Sri Lanka. The objective of this study was to assess the risk factors of chronic disease and the association with physical activity for adults in the Colombo Municipal Council (CMC) area.

Background

'The Global Strategy on Diet, Physical Activity and Health' endorsed at the 57th World Health Assembly states that a “profound shift in the balance of the major causes of morbidity and mortality has already occurred in the developed countries and is underway in many developing countries”. The World Health Report 2002, 'Reducing Risks, Promoting Healthy Life', shows that few risks are responsible for a large number of premature deaths and account for a big share of the global burden of disease. The immediate risk factors for chronic diseases are raised blood glucose, high blood pressure, high concentrations of cholesterol in the blood and overweight or obesity. Physical inactivity and tobacco use, along with poor diet, are the common modifiable risk factors. In Sri Lanka a changing trend in the pattern of disease burden is observed. Trend analysis using Registrar General’s data shows that chronic disease mortality rates are increasing rapidly during the past decades. In 2001, 71% of all deaths in Sri Lanka were due to chronic diseases. Chronic disease mortality is reported to be 20-30% higher in Sri Lanka than in many developed countries. According to the Annual Health statistics, coronary heart disease was the leading cause of hospital deaths in Sri Lanka since 1997.

Objectives

Urbanisation and other socio economic changes have led to changes in individuals’ lifestyle thereby causing an increase in the intermediate risk factors of chronic diseases, such as raised blood pressure, raised blood glucose, abnormal blood lipids and overweight/obesity. However, to further understand the problem it is necessary to study these intermediate risk factors and the common modifiable risk factors in the most urbanized part of Sri Lanka namely the CMC area. This study aims to assess these risk factors and the association of physical activity for adults in the CMC area.

Methodology

Study design and area: This was a cross sectional study of a representative sample of adults aged 20-59 (both inclusive) years living in the CMC area in which has the highest population density, and covers most of the metropolitan and the economic area in Sri Lanka. Study population: All adults living in the area for a continued period of not less than six months were the study population. The exclusion criteria were: institutionalised adults, adult visitors to the study area, pregnant females up to postpartum period of 3 months, adults with severe psychiatric illness and those not providing consent. Sampling: Four hundred adults were selected using a probability proportionate to size cluster sampling method. The Primary Sampling Unit was a ward in the CMC area which is similar to a village structure. The Grama Niladhari (village headman) in each ward helped the data collectors to locate the selected houses. Within the household an adult was selected using a random procedure. Only one eligible individual was selected from a household so as to minimize cluster effect, as members of the same household share similar life styles. Recruitment was done irrespective of the availability of the study participants in the house at the time of the first visit to the households. The cluster was considered as complete when 40 consenting eligible people were identified and interviewed.Measurements: An interviewer administered questionnaire consisting of socio-demographic, economic characteristics was used to collect data. Medically trained officers interviewed individuals and assessed the disease status by questioning and going through medical records. Physical activity was assessed using the validated long version of the international physical activity questionnaire and individuals were classified into ‘sufficient activity’ and ‘insufficient activity. Trained personnel took anthropometric measures of height and weight from all participants.Ethics: All participants received an information sheet about the study and signed a consent form if they agreed to participate. Ethical clearance was obtained from the Ethics Review Board of the Faculty of Medicine, University of Colombo. The provincial and the district government authorities gave permission to carry out the study in their area.

Statistical analysis: Descriptive analysis was done using chi square tests. All analysis were conducted using SPSS software version 17.

Results

Out of the 400 participants 43% (n=172) were males and 57% (n=228) were females. Only 46% (n=184) had a G.C.E. ordinary level education or more and 86.3% (n=345) had an income of less than Rupees 30,000. Fifty four percent were between 40-59 years of age while the rest (46%) were between 20-49 years of age.
The self-reported prevalence of type 2 diabetes mellitus was 12.3% (n=49) while the prevalence of raised blood pressure and abnormal lipds were 13.3% (n=53) and 5.5% (n=22) respectively. The majority (60.5%, n=242) were overweight while another 7% (n=28) were underweight. More than half (64.5%, n=258) of the participants had at least one immediate risk factor for NCD, and out of them 110 (27.5%) were 40 years or less. Of the sample 11.8% were current smokers and 14.5% were previous smokers.
Seventy two precent (n=288) of the participants were in the ‘sufficiently active’ category, with activity accumulated mainly through household, travel and job related behaviours. However, 85.8% (n=343) reported no leisure-time PA, and 21.3% (n=85) reported that they did not walk either for travel or leisure for more than 10 minutes a week. No active transport (walking/cycling) methods were used by 23.5 % (n=94). Of those who were had at least one immediate risk factor 85.6% (n=221) had no leisure activity while 21.3% (n=55) and 93.4% (n=240) reported no walking or cycling during the previous week.
Having an immediate risk factor for chronic disease was not statistically significantly associated with socioeconomic or demographic characteristics of the individuals. This study also did not find a strong evidence of association between the presence of at least one immediate risk factor and physical activity.

Conclusion

An alarming percentage of immediate risk factors were observed in the CMC area although no particular socioeconomic and demographic group was more affected than the others. The major contributors to energy expenditure in the local setting according to this study were housework, transportation and job related activities. This is different to the pattern seen in the developed countries. Being active while attending to day to day chores should be encouraged and promoted in the developing countries since it is already their habitual practice. Special concern is necessary due to the counteracting forces of rapid urbanisation taking place in Sri Lanka which makes it more convenient and fashionable for people to use mechanical equipment for housework, to seek sedentary jobs and use motorised vehicles for transport. Since it is seen that most of the participants in the present study enacted their activity from transportation it is necessary to promote active transportation. Thus the importance of an activity friendly physical environment with good street structure to facilitate walking and cycling, traffic and general safety, access and connectivity needs to be highlighted.
Strength and limitations: This study explored the burden of risk factors in the most urban part of Sri Lanka and its association with physical activity. Physical activity measurement, although validated for Sri Lanka, was carried out through self-reports. Thus there was a possibility for recall bias and for over-reporting or under-reporting the number of occasions and time spent on physical activity in different domains. This is due to various reasons such as social norms determining socially acceptable answers. A cross sectional study design had to be used. Therefore causal interferences cannot be made because of the inability to determine the temporal sequence.

A total of 895 participants from 70 countries including policy makers, health professionals, academics and NGO frontliners all shared their view points and experiences and the sessions emphasised how complex the issue of chronic diseases is to address and that there is no magic bullet. Is it Youth empowerment or the use of new technologies? Is it redesigning health systems or putting more of an emphasis on primary health care? Is it addressing the way we all are living in a more sedentary and unhealthy environment or tackling the challenge in those who are most at risk? So many questions still remain after the Forum, but some key lessons:

Research and its role to sometimes highlight the obvious, but to be used as an effective tool for project implementation, monitoring and evaluation and policy change

Innovative approaches that are adapted to the context we work in, that are sustainable and scalable, but that technology should not drive the answer, but be one of many tools used

We need a multi-discipline and multi-disciplinary approach and this will require changing the way we think about chronic diseases, how we teach medical and nursing students about chronic diseases and how we move the issue of chronic diseases from being something purely dealt with by the health sector to truly a whole of government and society approach

The health systems clinicians work in, whether in Switzerland or Uganda need to be reorganised to address chronic diseases. This will require in some cases decentralisation of care to the primary health care level, development of new roles for health professionals, avoiding verticalisation and a disease based approach and integration of different aspects of the health system

The role partnerships will play in addressing this challenge is necessary, however we need to address issues of conflict of interest and trust, but these can be overcome

Hearing from people with chronic diseases, innovators, philosophers, health system specialists, researchers, health professionals or policy makers the common theme was putting the individual with the chronic condition, the beneficiary of our actions and activities at the centre for what we do. We are all working as was stated by Sridhar Venkatapuram for the noble cause of improving health, in addressing chronic conditions we must not forget that we are working to ensure that children in Nepal do not develop cardiovascular risk factors, that people with sickle cell disease receive the treatments they need, when they need them, and that the health system should work for and with the person for improved health and not be a barrier to this.

In the session on innovationMahad Ibrahim argued that space for innovation is necessary and the aim of this edition of the Forum was to provide such a space. With the issues addressed during the Forum it was not only innovative work that was presented, but also the approach to learning and sharing ideas at the Forum and not letting individual’s expertise get in the way of new ideas.

After the session on health systemsAndy Williamson said he felt encouraged after having heard from a policy maker, an academic, someone working for an NGO and a clinician in a hospital. The challenge is great, but the inspiring and innovative approaches presented at the Forum show us what can be done and that the lessons presented will help in addressing chronic diseases in different settings and make a change to the lives of people living with chronic diseases throughout the world.

Reporting at the Geneva Health Forum also took an innovative and participative approach. Different participants contributed not only in terms of feedback on the sessions on content and quality, but were also able to give their perspectives on the content presented. Students from Boston University for example prepared presentations on their experience and what they learnt at the Forum. Students from the University of Geneva’s Institute of media, communication and journalism also attended some sessions and provided insight into how experts in the field of health communicate on certain issues. Travel grantees and other key participants reported on the sessions they attended by adding their view to the issues addressed. All this material is presented in the final report from the 2012 edition and the issues raised in this report will shape the discussions and content of the Geneva Health Forum in 2014.

WHO defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings. The upper-middle class society of India is no far from this fact. Education, being given prime importance, the educated Indian parents wants their precious child to become an intelligent. They often fail to allow their kids to concentrate on sports and other physical activities. The same is merely absent in case of a girl child.

Summary/Objectives:

The present study was aimed at evaluating the role of change in life style in prevention of obesity. A total of 40 families comprising of 1302 subjects were enrolled into the study. Demographics, food habits, health status and various other relevant data were collected from the study participants in a well structured proforma, made especially for this study. The sample included 21% aged between 11 and 17; 63% between 18 and 46; and 16% between 46 and 70. The subjects were counselled extensively about the importance of diet and exercise in maintaining good health. They were also explained about the ill effects of obesity and its complications. Pamphlets of the same were also distributed. Weight and BMI of all the subjects were measured and recorded at the end of the counselling. They were advised to avoid high-fat diet and practice exercise/yoga/walking for at least 15-30 minutes daily for a month period.

Results:

Subjects were contacted a month later. Only 48% of the total subjects strictly followed the advice and the remaining score were considered as lost to follow up; as they could not practice exercise/yoga daily and/or could not avoid fast/junk/high-fat food items due to various reasons. The prominent amongst that was their busy schedule (59%). 43% of those who completed the study in its entirety were found to have reduced their weight by 1-3 kg within a month’s time. All those who have benefited from this study did not fail to appreciate the role of exercise and diet modification in their weight loss.

Lessons learned:

The current study showed that the life style modification have significant role in preventing the obesity. Although obesity is an individual clinical condition, it is increasingly viewed as a serious and growing public health problem: excessive body weight has been shown to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnea and osteoarthritis. Most researchers have concluded that the combination of an excessive nutrient intake and a sedentary lifestyle are the main cause for the rapid acceleration of obesity in Western society in the last quarter of the 20th century. When income differentials were factored out, the inequity persisted—thin subjects were inheriting more wealth than fat ones. A higher rate of a lower level of education and tendencies to rely on cheaper fast foods is seen as a reason why these results are so dissimilar. The importance of being fit and healthy by consuming low-fat diet and practising few simple exercises regularly.

Obesity is associated with the development of cardiovascular risk factors including hypertension , type 2 diabetes mellitus and hyperlipidaemia.

Summary/Objectives:

The present study aims to evaluate prevalence of hypertension and its association with obesity and abdominal obesity in students of Rafsanjan University of Medical Sciences. In this descriptive study, 694 respondents selected using census method. Study was carried out using a questionnaire and standard equipment. Hypertension and obesity were detected using JNC7 and WHO classification respectively. Data were analysed using SPSS 12. Appropriate tests were applied based on the variables scale and nature.

Results:

Results of this study demonstrated that 27.4 %and 28% respondents had systolic and diastolic abnormal blood pressure (>=120/80 mmHg) respectively. Ten point seven percent and 60% respondent with overweight and obese had abnormal blood pressure respectively. These differences were statistically significant (P<0.05). Additional abnormal diastolic blood pressure was found in 36.5% overweight students and 60% in obese respondents (P<0.05). According to BMI measurement 10.7% and 1.4% students were overweight and obese. 3.17% of girls and 8.8% of boys had abdominal obesity. There was a significant correlation between abdominal obesity with systolic and diastolic blood pressure respectively (r=0.28 – P=0.01) and (r =0.18 – P=.0.01)

Lessons learned:

The amount of students with abnormal blood pressure , obesity and abdominal obesity in our findings are very important. Therefore screening programmes for detection syndrome metabolic and interventional approaches are need for university nutritional programmes.

The rising incidence of Hypertension is being recognized as a public health problem and is strongly related to the aging of the population, urbanization and socio-economic changes favouring sedentary life style ,obesity, alcohol and tobacco consumption, high salt intake and mental stress.

The mean age of the study participants was 27.54 + 6.9 years. The prevalence of hypertension in the study group was 9.4% (CI: 6.7-12.1) while almost half (48.2%) fell under the category of prehypertensives. Out of the total 42 screened hypertensive patients in our study 11 were unaware of their condition (26.2%). A statistically significant rising trend of BP was observed with age .The prevalence of risk factors of hypertension among the study subjects was as follows: High salt intake (10.9%), BMI> 25.0 (17.3%), BMI >30.0 (5.1%), central obesity (11.1%), mental stress (6.4%) and sedentary lifestyle (55.8%). Smoking was reported in 1.5% study subjects while none of the women in our sample reported alcohol consumption.

Lessons learned:

The prevalence of prehypertension in the study sample was reported to be high. Thus emphasis should be laid on those with BP in the pre hypertensive stage as they are the ones most predisposed to develop hypertension in future and prevention at this step can prevent a major financial burden for the nation. Almost a quarter of screened hypertensives were unaware of their BP status. The results of the present study indicate the need to plan and implement actions on prevention, detection and treatment of hypertension as a part of a comprehensive programme of hypertension control in the community. Only a comprehensive strategy based upon the public health approach will be able to stem the increasing prevalence of risk factors of hypertension.

Diabetes is a chronic condition affecting more than 250 million people worldwide and kills 3.8 million people per year (Diabetes Atlas, 4rd edition, 2009). According to the International Diabetes Federation (IDF) in 2025, diabetes will affect more than 380 million people, becoming one of the leading causes of disability and death worldwide. Developing countries would be most concerned by this pandemic, comprising 76% of PAD in the world. This epidemiological transition “rich” countries to “poor” countries is mainly due to changes in lifestyle including increased urbanization, nutritional transition, decreased physical activity and a sharp rise in overweight. The report of WHO Consultation on obesity shows that the growth of obesity in children is not limited to industrialized countries. The WHO has highlighted in this report, the fact that children in the developing world, who are face at a nutritional transition have a greater risk of obesity. It is therefore very important to take preventive action in children because adequate lifestyles (diet, physical activity, weight etc...) are set in early childhood, knowing that bad habits are more difficult to correct they are old or in family.

Methods:

The approach developed is based on active student participation through creative workshops using the comic. In a first phase, teachers and drawers have been trained on diabetes, its risk factors and prevention actions. In a 2nd phase, drawers and teachers were provided in each class a series of 3 animations using drawing tools and tools developed specifically for this activity (Game “family’s dishes” and game “what are you thinking”?). Each workshop was structured around 3 activities:
- Passage 1: the facilitators presented the disease, its risk factors and prevention actions to prevent risk factors (diet, physical activity etc. ...). At the end of this session, students have all information about diabetes, how to prevent it and also will carry out the message with other students and their parents.
- Passage 2: this workshop is devoted to the initiation on techniques of creating the Comics. At the end of the introduction, students write their script or their history. The first drafts of drawings are made.
- Passage 3: finalization and collection of draws of students. Students present theirs comic with stories on their environment, health, food and physical activity.
Finally, in a final round one-day exhibition and animation was done in each school. The draws done by students have been incorporated into exposure and were presented to all students of the school. During the exhibition, activities were conducted: sets of images on diabetes, games with questions and answers and drawing workshops on site. The exhibition has mobilized not only school students but also parents who came to see the accomplishments of their children and have had access to information and a free screening of diabetes mellitus. An evaluation through pre and post test was developed to measure the impact of these events on the knowledge of these students.

Results/Conclusions:

8 designers and 16 teachers were trained. The animations were made in 8 schools have earned 16 classes and 501 students. 2 one-day exhibition in 2 schools met 2000 children and parents. At the end of the full cycle of animation we did observe a strong increase students’ knowledge on various items addressed in this project.

In Bulgaria and in the developed countries, an epidemiologic increase of the rate of psychogenic eating disorders (hyperphagia, anorexia, bulimia), as well as lowering and broadening of the age limit of affected persons can be observed. The reformation of the Bulgarian healthcare system needs to give an effective response to the social needs on health preservation, and a quality and accessible medical care.

Methods:

The attitudes toward and awareness on contracting hyperphagia, anorexia, bulimia, and the options, demand, and barriers of the access to care for patients with a psychogenic eating disorder have been studied. 700 individuals (with an eating disorder and risk groups), over 12 years of age, from various different size populated areas in the country have been covered.
Methods: survey method, clinical surveillance, documentary method for research of the official statistical information, mathematical and statistical analysis.

Results/Conclusions:

Statistical data show two extreme tendencies among the young population - obesity and underweight. One of every five Bulgarian scholars is overweighted, and Bulgaria is the second country in the world, after the USA, with most overweighted and obese citizens. 17% of the women aged between 18-30 years, and 8% of the girls below 18 years of age are underweighted. Data published in 2008 report that 250,000 patients suffer from an eating disorder. 63% of the men, and 46% of the women of economically active age are overweighted, 17% of the men and 19% of the women are obese (2008). Data analysis performed within this study identified several basic issues: with a morbidity rate in raise, there is a lack of awareness of the severity of the somatic and psychic consequences and complications of these conditions, and of the development of severe secondary diseases; the real danger and risk of a lethal income is not being taken into account. 73% of the surveyed stated their need of health information for eating disorder prevention and treatment.
Results from the study brought forward the problematic aspects in the treatment of psychogenic eating disorders. Access barriers to treatment depend to a large extent on what is being currently offered – a lack of specialized institutions. Only a few populated areas have specialists – physicians, psychotherapists, who are trained to treat psychogenic eating disorders, however their number is insufficient. Access to these specialists is associated with additional travel and stay costs, absence from school or work. Mean treatment period of the studied patients is 6 months to a year. There is no ‘clinical pathway’ to entirely or partially cover the treatment, which is the practice in some other countries. This treatment is entirely covered by the patient (direct payments by the patient). The attitudes toward searching a treatment outline two alarming tendencies – insufficient motivation for treatment, and unawareness of the risk to health. Main reasons for these are unwillingness or fear and shame of recognizing the disease, financial incapability. A certain part (32%) of the studied individuals share that they have no faith in the treatment effectiveness and successful outcome. This results in worsening of the eating disorder and complicating its successful treatment, and in increasing of the secondary somatic complications. Data from the study allow for the following conclusions and recommendations: An appropriate funding needs to be ensured in a rational and effective way in terms of costs and needs for access to treatment, for opening specialized centers, for a focused training of professionals, and for the development of preventive actions and programs.